下顎第一大臼歯根分岐病変に対して自家象牙質顆粒と血小板リッチフィブリン膜を併用して治療した93症例の評価

[Evaluation of 93 cases of mandibular first molar root bifurcation lesions treated with autologous dentin Granules combined with platelet-rich fibrin membrane].

• Zheng-Rong Wu
• Yuan-Lin Zuo
• Chao-Hui Li

抄録

目的:

下顎第一大臼歯根分岐病変の治療において、自家象牙質粒子と血小板リッチフィブリン膜（PRF）を組み合わせた治療法の有効性を検討する。

PURPOSE: To investigate the efficacy of autologous dentin particles combined with platelet-rich fibrin membrane (PRF) in the treatment of root bifurcation lesions of mandibular first molar.

方法:

2016年2月から2017年10月までに当科から下顎第一大臼歯根分岐病変を有する患者93名（93歯）を選抜した。彼らは無作為に2群に分けられた。実験群の46名（歯数46本）の患者さんには血小板リッチフィブリン膜と組み合わせた自家象牙質粒子を、対照群（歯数47本）の特許さんにはコラーゲン膜で覆われた骨欠損部にBio-Ossを移植して治療を行っていただきました。術後1、3、6、12ヶ月後に再審理を行った。手術群の成功率、歯周ポケットの深さ（PD）、アタッチメントの喪失（AL）、根分岐部の貫入深さ（HPD）、治療前後の根分岐部の骨密度を測定した。データを記録し、SPSS25.0ソフトウェアパッケージを用いて比較した。

METHODS: Ninety-three patients (93 teeth) with mandibular first molar root bifurcation lesions were selected from our department from February 2016 to October 2017. They were randomly divided into 2 groups. Forty-six patients with 46 teeth in the experimental group underwent autologous dentin particles combined with platelet-rich fibrin membrane, while patents in the control group (47 patients with 47 teeth) were treated with Bio-Oss implanted in the bone defect area covered with collagen membrane. The patients were revisted at 1, 3, 6 and 12 months after operation. The success rate of the operation group, the depth of periodontal pocket (PD), the loss of attachment (AL), the depth of penetration of the root bifurcation (HPD), and the bone density of the root bifurcation area before and after treatment. The data were recorded and compared with SPSS25.0 software package.

結果:

成功率は実験群97.83%(45/46)、対照群85.11%(40/47)であり、両群間の差は有意であった(P<0.05)。治療後、PD、AL、HPDは有意に減少し(P<0.05)、MGVは徐々に増加した。治療前と治療1ヶ月後のMGVsには、実験群では有意差はなかった(P>0.05)。それ以外の時点でのMGVは、対照群と比較して有意に高かった（P＜0.05）。実験群のPD、AL、HPDは、治療後の各時点で対照群に比べて有意に低く（P＜0.05）、MGVs値は対照群に比べて有意に高かった（P＜0.05）。合併症の発生率には有意差はなかった(4.35% vs 6.38%、χ=0.189、P>0.05)。

RESULTS: The success rate was 97.83%(45/46) in the experimental group, 85.11%(40/47) in the control group, the difference between the two groups was significant(P<0.05). After treatment, PD, AL and HPD decreased significantly (P<0.05), and MGVs increased gradually. There was no significant difference in MGVs before treatment and 1 month after treatment in the experimental group (P>0.05). MGVs at other time points were significantly higher than those of the control group (P<0.05). PD, AL and HPD of the experimental group were lower significantly than the control group at each time point after treatment (P<0.05), and MGVs value was significantly higher than the control group (P<0.05). There was no significant difference in the incidence of complications(4.35% vs 6.38%, χ=0.189, P>0.05).

結論:

下顎第一大臼歯根分岐病変の治療に自家象牙質顆粒と血小板リッチフィブリン膜を併用することは有効であり、広く応用する価値がある。

CONCLUSIONS: Autologous dentin particles combined with platelet-rich fibrin membrane is effective for the treatment of root bifurcation lesions of mandibular first molar, which is worthy of wide application.